DSHS strives to respond to all email requests in a timely manner. It is important to note, however, that messages that you send to us by email may not be secure and may be intercepted by a third party. Therefore, we recommend that you do not send any confidential health information to us by email.

Deaths Due to HIV Disease

The mortality rate allows for a quick look at the impact of HIV disease on overall deaths in the state. Mortality rates for HIV/AIDS were calculated using cases which had HIV disease listed as the underlying cause of death on the death certificate.

Figure A

Figure A

In 2007, the United States reported a mortality rate of 3.7 per 100,000 due to HIV disease. Healthy People 2020 set a goal of improving this mark by ten percent, resulting in a goal mortality rate of 3.3 per 100,000. Although Texas is not currently meeting this mark, the state has been making steady progress towards the goal, decreasing the mortality rate due to HIV disease each year between 1999 and 2008. In addition, the mortality rate in Texas has been in line with that reported nationwide in each calendar year.

Figure B

Figure B

Figure B breaks down the Texas mortality rate by race and ethnicity. The high mortality rate among black cases is of most concern. While all other racial groups are at or below the Healthy People 2020 target mortality rate during the years of interest, the mortality rate among black HIV/AIDS cases has been five to six times higher than the reported mortality rates among white and Hispanic HIV/AIDS cases. All groups have seen decreases during the years of interest. However, the mortality rate among blacks has had a smaller overall decrease compared to whites and Hispanics. Cases in the other category were not included due to statistically unreliable data.

Survival Proportions

When analyzing survival, the length of survival after an AIDS diagnosis is of the most interest. Due to the potential for late diagnoses, calculating survival after a diagnosis with HIV may not accurately show the length of time a case survived while infected with the virus. In addition, using the date of diagnosis with AIDS can allow the inclusion of cases diagnosed with AIDS prior to 1999.

Figure C

Figure C

The percentage of Texas AIDS cases surviving at least 36 months after being diagnosed with AIDS has held fairly steady. Nationally, the percentage surviving has slowly increased among each cohort of diagnosed cases. However, neither group has reached the Healthy People 2020 goal of 90.2% surviving at least 36 months after the AIDS diagnosis. When looking backwards, the survival proportion among Texas cases has remained about the same since 1997.

Figure D

Figure D

Figure D breaks down the survival proportions for those cases diagnosed with AIDS in 2005 by gender and race. The other category was not included in this graph due to statistically unreliable data. Notably, each racial category shows different survival proportions when stratifying by the case’s gender. White women had the fewest cases survive at least 36 months after diagnosis while Hispanic women and white men had the most cases survive. Very little difference in survival was observed between black men and black women.

Years of Potential Life Lost

Calculating the years of potential life lost (YPLL) allows for public health officials to look at mortality differently. Whereas raw counts can determine how many people died from HIV disease, years of potential life lost can describe how many years of life were lost, assuming a person would live to the age of 75, due to HIV disease. Younger people will contribute more years to the overall statistic and can help emphasize whether a larger burden of death occurs among younger populations.

Figure E

Figure E

Figure E shows that the years of potential life lost per 100,000 among Texas HIV/AIDS cases has steadily been decreasing between 2004 and 2008. While this number alone cannot tell whether this decrease is due to fewer HIV cases dying from HIV disease or to cases surviving with the disease to an older age before dying, either outcome can be considered progress.

Figure F

Figure F

Since 1990, over one million years of potential life have been lost due to HIV disease. A majority of these years were accumulated prior to 1997, as annual totals have slowly decreased since 1997. White HIV/AIDS cases have contributed to almost half of this total, but much of that was accrued before 1997. Because no information on population was available before 1990, deaths occurring from 1987–1989 have been excluded from Figure F and Figure G.

Figure G

Figure G

Since 1990, white HIV/AIDS cases in Texas have accrued the most years of potential life lost compared to the other racial groups. However, when considering the mean years of potential life lost per 100,000 persons, black HIV/AIDS cases have a disproportionately high rate which is greater than three times that of white HIV/AIDS cases. The total population of blacks in Texas is much smaller than that of whites in Texas. Thus, each individual year of potential life lost among black HIV/AIDS cases will contribute more to the overall rate among blacks. In addition, while all groups have seen decreases in years of potential life lost over the last ten years, the decrease has been much less pronounced among black HIV/AIDS cases.

Trends in Underlying Causes of Death

An analysis was conducted on the causes of death to determine whether potential trends observed within counts of death by specified causes actually existed or if it was an artifact created by the case population. The regression analysis only looked at HIV disease, malignant neoplasms, and major cardiovascular disease as these three groups were responsible for the most deaths among HIV patients.

Figure H

Figure H

The analysis showed that, each year, the number of deaths due to HIV disease decreased by 1.2 percent and the number of deaths due to malignant neoplasms and major cardiovascular disease increased by 4.2 and 4.6 percent, respectively.

Figure I helps to illustrate how the yearly percent change for these causes of death can ultimately affect the distribution of deaths, especially in terms of the decrease in deaths due to HIV. Although all other cause of death groups contribute a larger proportion to the overall burden of death, malignant neoplasms and cardiovascular diseases show the largest proportional increase from 1999–2008. This increase may indicate that HIV/AIDS cases are living longer and therefore are at an increased risk of dying from a chronic condition rather than HIV disease itself.

Figure I

Figure I

Although comparisons cannot be made between deaths occurring before 1999 and those occurring from 1999 and later, some similarities are observed in the trend analysis. The decrease in the proportion of deaths due to HIV disease began to arise in the mid-1990’s. Increases in deaths due to malignant neoplasms and cardiovascular diseases are also seen in this earlier timeframe, but the magnitude of the increase differs between the two conditions. Information about why death data between the two time periods cannot be directly compared is included in the notes section.

Third Level Supplement: Data Sources and Matching

Cause of death information was gathered from match results of eHARS cases with the National Death Index for the years 1980-2008 and with death information provided by Texas Vital Statistics for 2009 and 2010. The National Death Index compiles death information from all 50 states, which allows for ascertainment of causes of death occurring outside of Texas which would normally not be collected. Because the National Death Index had death information available up to 2008, deaths among Texas HIV/AIDS cases occurring out of state after 2008 would not be known unless reported by outside health departments to Texas surveillance offices. Therefore, statistical analyses excluded deaths occurring after 2008.

In 1999, cause of death codes on death certificates switched from International Classification of Disease-9 (ICD-9) to ICD-10. A previous study which looked at coding differences between ICD-9 and ICD-10 using a single year of data showed about a 10% increase from ICD-9 to ICD-10 in cases where HIV disease was the underlying cause of death. Code wasn’t available to account for both the differences in coding individual conditions as well as methodology for determining the underlying cause of death. When tabulating counts, cases which died in 1987-1998 were included. Any calculations of rates or evaluation of trends only used cases which died after 1998. Graphs which include data on deaths occurring before 1999 are only provided for reference; no direct comparisons can be made between the two coding eras.

Rates by sex and by racial group (white, black, Hispanic, and other) were calculated using denominator data provided by the Texas Center for Health Statistics. When graphing rates for a timeframe which includes both ICD-9 and ICD-10 years, a break was included in the graph to avoid including coding differences when looking at temporal trends.

Mortality Rate

National mortality rate data was gathered from DATA2010: the Healthy People 2010 Database. National mortality rate information was not available for 2008.

Survival

Length of survival was calculated by subtracting the date of the initial diagnosis from the date of death. If a case only had a month and year of diagnosis listed, the day of death was assumed to be the 15th of the month. If the month or year of diagnosis was missing, the case was excluded from analysis.

Table 2 Survival of Cases Diagnosed with AIDS, 1987-2005 by Year of Diagnosis

Year ofDiagnosis

CasesDiagnosed

Lived at Least 36 Monthsafter AIDS Diagnosis

#

%

1987

2,197

410

18.7

1988

2,527

579

22.9

1989

3,154

920

29.2

1990

3,623

1,114

30.8

1991

3,969

1,286

32.4

1992

4,966

1,843

37.1

1993

5,175

2,436

47.1

1994

4,748

2,701

56.9

1995

4,599

3,130

68.1

1996

4,617

3,593

77.8

1997

3,799

3,085

81.2

1998

2,896

2,333

80.6

1999

2,808

2,276

81.1

2000

2,604

2,094

80.4

2001

2,803

2,259

80.6

2002

2,831

2,271

80.2

2003

2,881

2,390

83.0

2004

3,006

2,480

82.5

2005

2,966

2,460

82.9

Table 3 Survival of Cases Diagnosed with AIDS in 2005, by Race and Sex

Race

Gender

CasesDiagnosed

Lived at Least 36 Monthsafter AIDS Diagnosis

#

%

White

Male

749

606

80.9

Female

112

86

76.8

Black

Male

781

642

82.2

Female

409

3,333

81.4

Hispanic

Male

732

598

81.7

Female

176

151

85.8

All

2,603

2,093

80.4

Years of Potential Life Lost

Years of potential life lost (YPLL) was calculated by subtracting a case’s age at death from 75; if a case was 75 or older at death, YPLL was set to zero. To calculate the rate for a single year, the sum of all YPLL amassed by a population was divided by the total population under the age of 75 living during the year of interest. A case was included in the yearly YPLL totals if a code for HIV disease was listed either as the underlying cause of death or a contributing cause of death. To calculate the rate for multiple years, the mean yearly YPLL of the years of interest was calculated, and this value was then divided by the population under the age of 75 in the year 2000.

Table 4A Years of Potential Life Lost per 100,000, by Race, 2004-2008

2004

2005

2006

Deaths

YPLL

YPLL/100,000

Deaths

YPLL

YPLL/100,000

Deaths

YPLL

YPLL/100,000

All

1,004

34,087.7

158.8

956

32,183.7

147.4

983

32,527.9

144.8

White

345

11,290.4

107.8

311

10,340.5

98.8

306

10,083.9

95.5

Black

423

14,987.7

602.1

424

14,214.3

564.5

448

14,911.2

559.3

Hispanic

229

7,589.1

98.7

214

7,373.6

92.5

222

7,276.7

87.6

Other

7

220.6

26.5

7

255.3

29.2

7

256.2

27.8

Table 4B Years of Potential Life Lost per 100,000, by Race, 2004-2008

2007

2008

Deaths

YPLL

YPLL/100,000

Deaths

YPLL

YPLL/100,000

All

946

30,949.6

135.5

855

27,172.3

116.9

White

315

10,150.7

96.1

244

7,443.0

70.4

Black

445

14,818.0

549.0

372

11,740.3

428.8

Hispanic

179

5,712.8

66.4

210

6,890.5

77.2

Other

7

268.1

27.7

29

1,098.6

108.0

Table 5 Years of Potential Life Lost, by Race, 1990-2008

Year

WhiteYPLL

BlackYPLL

HispanicYPLL

OtherYPLL

TotalYPLL

1990

46,730.5

12,897.8

10,653.1

276.4

70,557.9

1991

48,966.6

17,473.6

13,708.6

151.5

80,300.3

1992

53,714.6

23,625.3

14,782.3

512.7

92,635.0

1993

57,352.9

24,623.9

17,191.9

155.8

99,324.4

1994

60,626.0

28,794.0

19,619.5

282.6

109,322.0

1995

56,653.0

31,701.6

20,259.9

437.1

109,052.0

1996

39,119.2

26,048.2

17,160.8

332.2

82,660.0

1997

20,431.6

17,950.0

10,747.2

440.6

49,569.4

1998

14,816.5

15,732.5

7,376.9

226.8

38,152.6

1999

13,919.3

15,088.4

7,154.5

230.4

36,392.5

2000

13,681.0

15,624.5

7,789.8

74.9

37,170.3

2001

13,496.6

14,972.6

7,504.5

102.8

36,076.4

2002

13,358.1

14,764.9

7,919.6

261.4

36,304.0

2003

11,794.7

14,004.3

8,024.3

142.8

33,966.1

2004

11,290.4

14,987.7

7,589.1

220.6

34,087.7

2005

10,340.5

14,214.3

7,373.6

255.3

32,183.7

2006

10,083.9

14,911.2

7,276.7

256.2

32,527.9

2007

10,150.7

14,818.0

5,712.8

268.1

30,949.6

2008

7,443.0

11,740.3

6,890.5

1,098.6

27,172.3

Total

513,969.0

343,973.0

204,736.0

5,726.8

1,068,404.0

Underlying Cause of Death Trends

Yearly percent change was calculated using a Poisson regression. Univariate models were built using age, sex at birth, race, date of first diagnosis, and stage of disease at first diagnosis (HIV or AIDS) as covariates for each of the three diseases groups of interest: HIV disease, major cardiovascular disease, and malignant neoplasms. If a covariate was found to be significant in the univariate model, it would be included in the multivariate model. To determine the final multivariate model, significant covariates were added to the model one at a time; if the addition of a covariate did not significantly differ from the reduced model, the covariate was excluded from further analysis.

Table 6A Number and Percentage of Deaths Among Texas HIV Cases by Cause of Death Groups, 1999-2008

1999

2000

2001

2002

2003

#

%

#

%

#

%

#

%

#

%

All

1,304

--

1,369

--

1,406

--

1,457

--

1,428

--

HIV Disease

1,003

76.9

1,065

77.8

1,021

72.6

1,038

71.2

1,005

70.4

MalignantNeoplasms

44

3.4

62

4.5

64

4.6

80

5.5

76

5.3

CardiovascularDisease

55

4.2

65

4.8

82

5.8

87

6.0

91

6.4

UnintentionalInjuries

24

1.8

25

1.8

31

2.2

51

3.5

37

2.6

IntentionalInjuries

21

1.6

26

1.9

31

2.2

22

1.5

36

2.5

Other

157

12.0

126

9.2

177

179

179

12.3

183

12.8

Table 6B Number and Percentage of Deaths Among Texas HIV Cases by Cause of Death Groups, 1999-2008

2004

2005

2006

2007

2008

#

%

#

%

#

%

#

%

#

%

All

1,497

--

1,369

--

1,538

--

1,500

--

1,398

--

HIV Disease

1,004

67.1

956

64.8

983

63.9

945

63.0

855

61.2

MalignantNeoplasms

98

6.6

109

7.4

111

7.2

101

6.7

101

7.2

CardiovascularDisease

95

6.4

95

6.4

112

7.3

127

8.5

135

9.7

UnintentionalInjuries

61

4.1

57

3.9

60

3.9

66

4.4

47

3.4

IntentionalInjuries

30

2.0

33

2.2

27

1.8

31

2.1

41

2.9

Other

209

14.0

225

15.3

245

15.9

230

15.3

219

15.7

Table 7 Cause of Death Categories were Defined by the Following ICD-10 Codes

HIV Disease

B20-B24

Malignant Neoplasms

C00-C97

Major Cardiovascular Disease

I00-I78

Unintentional Injuries

V01-X59, Y85, Y86

Intentional Injuries

X60-Y09, Y87.0, Y87.1

Any ICD-10 codes not mentioned above were included in the Other category.